An angel on my shoulder: a study of relationships between women with anorexia and healthcare professionals

Abstract

Adults with anorexia are an under-researched group because the usual focus is on adolescents. The relationships that occur between healthcare professionals and adults with anorexia are often challenging, because they do not necessarily agree on the goals of treatment. The therapeutic relationship is widely recognized as crucial to care, even healing and restorative in its own right but problematic in this setting. This is a phenomenological study of how therapeutic relationships are negotiated and maintained in a day care service. Six women with anorexia nervosa and seven of their healthcare professionals were interviewed in the care setting to explore their lived experience of their relationships. Six important themes emerged from the interviews: the authenticity of the relationship, safety, the externalization of the eating disorder, recovery measured in kilos, the power of hope and optimism and the use and acceptance of maternalism in the care setting. Findings suggest that patients appreciated the safety and security of care, but some were using the service as respite rather than recovery. Patients saw goals and tasks related directly to weight gain as irrelevant to their main concerns, but engagement with people who provided a secure, nurturing and maternalistic context for safety and optimism was seen as supportive.

‘Eating disorders are not about food, they’re about life’: Client perspectives on anorexia nervosa treatment

“…Similarly, the finding that the women wanted a 'real' relationship with their therapist was akin to Wright and Hacking's (2012) finding (in their study of relationships between women with anorexia and healthcare professionals) that: 'Both staff members and patients expressed the need to be "genuine", even "transparent" in order to establish an authentic and therapeutic relationship ' (p.110). It also echoes prior research on patient preferences about the importance of the therapeutic relationships in AN treatment (e.g.…”

Practice guidelines for acupuncturists using acupuncture as an adjunctive treatment for anorexia nervosa

“…1,13,16 It provides AN patients something to look forward to and a belief that things will get better. AN patients have been known to borrow their therapists' hope when they are struggling with their own beliefs about hopelessness.…”

“…Trust, non-judgement and safety are highly regarded and important to AN patients, 9,13,16 thus it is essential to practise safely and to be trustworthy and honest in all interactions. AN patients place a great deal of trust in their practitioners and believe that, in addition to being competent, practitioners will display qualities such as integrity, truthfulness, acceptance and compassion.…”

“…The therapeutic relationship is very important to AN patients' recovery, [13][14][15][16] however the development of the therapeutic relationship can be difficult and this may be more challenging in settings where there are disagreements, power struggles or competing goals of care and therapy. 14,15,17 It has been shown that non-familial relationships (with a partner or a therapist) play a major role in recovery for AN patients.…”

Talking about mental health nursing: a qualitative analysis of nurses’ and service users’ accounts

“…The origins of the therapeutic relationship can be traced to attendants' interpersonal practices in the asylum era (O'Brien, 2001), with a large body of literature promoting such alliances as crucial to positive outcomes for service users' mental health (Wright & Hacking, 2012). The forefather of advocating a focus on the therapeutic relationship is said to be Carl Rogers (1951), who identified essential attributes of respect, empathy and genuineness (Rolfe, 1990).…”